Remote DRG Auditor: MS-DRG & APR-DRG Expert

Elevance Health; United States; Remote; USD 93,000 - 160,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Elevance Health is seeking a DRG Coding Auditor with MS-DRG and APR-DRG expertise to audit inpatient medical records and improve claim recoveries. This remote role includes in-person training sessions and potential alternate locations within commuting distance, with a hybrid/virtual work policy in place.

Candidate will leverage ICD-10 coding knowledge, DRG concepts, and auditing tools to ensure accurate coding and compliant documentation across all lines of business.

Qualifications

• AA/AS degree or 5 years of auditing experience.
• RHIA/RHIT/CCS/CIC/CCDS certifications required.
• 5 years of experience with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG.

Responsibilities

• Audits inpatient medical records and generates high quality recoverable claims for all lines of business.
• Performs clinical reviews to evaluate coding and DRG assignment accuracy.
• Uses ICD-10 coding expertise and guidelines to substantiate audit conclusions.
• Generates audit findings letters and supports process improvement initiatives.

Skills

ICD-10 coding

DRG auditing

Clinical guidelines

Auditing tools

Education

AA/AS degree

5+ years claims auditing

Tools

RHIA

RHIT

CCS

CIC

CCDS

Job description

Elevance Health is seeking a DRG Coding Auditor with MS-DRG and APR-DRG expertise to audit inpatient medical records and improve claim recoveries. This remote role includes in-person training sessions and potential alternate locations within commuting distance, with a hybrid/virtual work policy in place.

Candidate will leverage ICD-10 coding knowledge, DRG concepts, and auditing tools to ensure accurate coding and compliant documentation across all lines of business.